Reprinted from Alien hand syndrome By Victor W Mark In: Gilman S, editor. MedLink Neurology. San Diego: MedLink Corporation. Available at www.medlink.com. Accessed 2008-04-13. Last reviewed January 22, 2007 Synonyms Alien limb phenomenon; Anarchic hand; Diagnostic dyspraxia; Groping-grasping reaction; Intermanual conflict; Magnetic apraxia; Strangelovian hand; Unilateral apraxia; Wayward hand Historical note and nomenclature Alien hand syndrome is not consistently or precisely defined. It describes complex, goal-directed activity in one hand that is not voluntarily initiated. The patient is unable to explain the source of such movement and may consider the limb to move as if it had a mind of its own. Essentially, two kinds of behavior are covered by this term (Feinberg et al 1992). The first consists of repetitive involuntary grasping. Beginning in 1900, Liepmann drew attention to the unilateral, disinhibited grasp reflex to tactile stimulation after cerebral injury (Liepmann 1905), although this phenomenon had been described by Kaiser as early as 1897 (Schuster 1923). Liepmann's detailed descriptions of disinhibited grasp reflex and unilateral apraxia quickly inspired other German investigators to contribute their own observations of acquired complex movement disorders. Among them, Van Vleuten reported a patient with a left hemisphere brain tumor that had invaded the corpus callosum (Van Vleuten 1907). The patient repeatedly grasped and put down an object with his right hand, apparently unintentionally. Goldstein first connoted the "alien" quality of unilateral repetitive grasping, the impression that an alternate entity is responsible for the behavior (Goldstein 1908). His patient complained, "There must be an evil spirit in the hand!" In succeeding years, such behavior became formally labeled by terms that included, "pseudospontaneous movements" (Wilson and Walshe 1914), Nachgreifen ("after-grasping") (Schuster 1923), "magnetic apraxia" (Denny-Brown 1958), “manual grasping behavior” (Lhermitte 1983), the "groping-grasping reaction" (Magnani et al 1987) and “visual groping” (Yagiuchi et al 1987). The second behavior covered by the term “alien hand syndrome” involves unilateral goal-directed limb movements that are contrary to the individual's intention and not accounted for by repetitious grasping or unilateral apraxia. Van Vleuten's patient appears to have been the earliest reported instance of this condition (Van Vleuten 1907). In this case, the patient's left hand was not only apraxic, but also performed markedly incorrect actions, such as touching his right hand instead of his nose, despite his understanding the command, and failing to move when commanded. Self-oppositional behavior, wherein one limb counteracts the declared or consciously intended action of the other limb, was often noted after complete or partial surgical division of the corpus callosum (callosotomy) to treat refractory epilepsy (Van Wagenen and Herren 1940; Smith and Akelaitis 1942). Akelaitis termed such behavior "diagnostic dyspraxia" (Akelaitis 1945).
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